Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1024*|*00501*357483908*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1024*483908*X*005010X279A1~ST*270*3908*005010X279A1~BHT*0022*13*202608101024000001*20260810*1024~HL*1**20*1~NM1*PR*2*NYSDOH*****PI*EMEDNY~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~PRV*PE*PXC*251B00000X~HL*3*2*22*0~TRN*1*202608101024000001*00000000ND~NM1*IL*1******MI*SD10714M~EQ*30~DTP*291*D8*20260806~SE*13*3908~GE*1*483908~IEA*1*357483908~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0624*^*00501*237441130*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062439*237441130*X*005010X279A1~ST*271*237441130*005010X279A1~BHT*0022*11*202608101024000001*20260810*062439~HL*1**20*1~NM1*PR*2*NYSDOH*****FI*141797357~PER*IC*EMEDNY PROVIDER SERVICES*TE*8003439000*UR*www.emedny.org~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~HL*3*2*22*0~TRN*2*202608101024000001*00000000ND~NM1*IL*1*FILIPEK*DEREK****MI*SD10714M~N3*7338 70TH ST                  2~N4*GLANDALE*NY*11385~DMG*D8*19620102*M~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*3KR4VP5RH68~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*237441130~GE*1*237441130~IEA*1*237441130~